Volunteer Screening Form

Friends of the Homeless of the South Shore is an Equal Opportunity organization. We do not discriminate on the basis of race, creed, sex, national origin or economic status of employees, volunteers or clients served. We do, however, screen all applicants paid or volunteer to ensure their suitability for the position involved.

Age 18 or Younger: Please be advised if you are under the age of 18, you need parental approval before submitting this form. We advise you that once you complete filling out the form, that you print the form out and have your parent(s) or guardian(s) sign it.

All other volunteers, we recommend that once the form is completed, you print out the form, sign it, and mail it to:

Friends of the Homeless of the South Shore
8 Driftway
N. Weymouth, MA 02191

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How did you hear about Friends of the Homeless of the South Shore?
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Other #1:

Other #1:

Other #1:

Education:

Degree 1:
Degree #2

Organization #1

Supervisor for Organization #1

Organization #2

Supervisor for Organization #2

Organization #3

Supervisor for Organization #3

Organization #4

Supervisor for Organization #4

Language #1
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Language #2
ReadWriteSpeakFluent

Language #3
ReadWriteSpeakFluent

Language #4
ReadWriteSpeakFluent

YesNo
Employer #1
Supervisor's Name:
Supervisor's Telephone (no dashes):

Employer #2
Supervisor's Name:
Supervisor's Telephone (no dashes):

YesNo
Reference #1 Name:
References's Telephone (no dashes):

Reference #2 Name:
Reference's Telephone (no dashes):

Reference #3 Name:
Reference's Telephone (no dashes):

YesNo

If yes, please elaborate:

Emergency Contact Emergency Contact #1 Name:
Emergency Contact's Telephone (no dashes):

Emergency Contact #2 Name:
Emergency Contact's Telephone (no dashes):

AGREEMENT

I UNDERSTAND that in no event shall the Department of Transitional Assistance or Friends of the Homeless of the South Shore, it's administrators, staff or volunteers, either individually or as a group, be liable to any party in the Friends of the Homeless of the South Shore program, or their heirs executors, administrators and assignees, for any liability resulting from Friends of the Homeless of the South Shore program activities.

I ALSO UNDERSTAND that the Department of Transitional Assistance and Friends of the Homeless of the South Shore, it's administrator, staff or volunteers, shall be held harmless from any and all suits, claims, loss, liability, or demands, arising out of, or resulting from Friends of the Homeless of the South Shore program activities.

By selecting "YES" I affirm that I agree.

YesNo

I accept the conditions of this section.

FOR THOSE UNDER THE AGE OF 18

I accept the conditions of this section.

PARENTAL APPROVAL AND COMMITMENT

I accept the conditions of this section.


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